Individual
DR. CLINT TEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(604) 984-1000
(601) 815-0434
Mailing address
504 CLINTON CENTER DR STE 4300, CLINTON, MS 39056-5610
(888) 815-2005
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
17473
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05426331
—
MS
05
—
1526782
—
TN
Enumeration date
07/11/2006
Last updated
11/19/2021
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